UROGENITAL DISORDERS IN WOMEN OF REPRODUCTIVE AGE WITH ANDROGEN DEFICIENCY

Abstract

According to the consensus of An Endocrine Society Clinical Practice in Princeton, USA, worsening well-being and dystrophic mood, permanent weakness and altered sexual function, including libido decline and lack of orgasm, were considered as typical signs of androgen deficiency syndrome. Particular attention is required to study the state of the genitourinary system, which is hormone dependent, so it is obvious that age-associated symptoms of pathological processes of the lower urinary tract are likely to be considered as a "urological mask" of the deficiency of sex hormones. Aim of the work. Identify and describe the most common urogenital disorders in women of reproductive age with androgen deficiency. Materials and methods. The study was conducted at the Ukrainian Scientific and Practical Center of Endocrine Surgery, Endocrine organs and tissues transplantation of the Ministry of Health of Ukraine during 2017–2018 years. A survey was conducted on 80 women of reproductive age who had major complaints of sexual disturbances (decreased libido and lack of orgasm, as well as dyspareunia as the main manifestations of androgen deficiency in women) and 30 healthy reproductive women without complaints of sexual dysfunction. General clinical methods were used (questionnaire of patients with a detailed study of socio-economic status, somatic, gynecological, obstetric and sexual history). The condition of external and internal genital organs was evaluated in the study of cervix and vagina in mirrors and gynecological bimanual study. At the same time, batches of analyzes for bacteriological research and colpocytology studies were conducted. The “HAWK 2102 EXL” (Germany) apparatus was used for ultrasound examination of pelvic organs using transabdominal and transvaginal convection sensors with frequencies of 3.5 and 5 MHz, respectively. Consultation of the urologist in order to exclude organic urological pathology and, if necessary, cystoscopy was also done. In the plasma of venous blood, the following hormonal indices were also determined by solid phase IFA, namely, content: free testosterone, DHEA, androstenedione, prolactin, ACTH, cortisol, FSH, LH, estradiol, progesterone. Results. It was revealed after exclusion of the urologist of the organic pathology of the urinary tract, in 49 % (39) of the main group, there were disturbances of urination associated with atrophic changes in the distal sections of the urinary tract. The revealed signs of vulvovaginal atrophy: pH 6.1±0.7 in women of the main group and pH 4.3±0.5 in women of the control group, in addition reduction of the karyopyknotic index and increase of the ripening index as signs of atrophic changes in the vaginal mucosa and cervical canal, was detected in 70 % (56) women in the main group and not found in the control group. At the same time, the prolapse of the genitalia of mild degree in women of the main group was detected in 32 % (27), and in the control group, this pathology was not found. Conclusions. Detection of these changes, which was considered characteristic of women in perimenopause and postmenopausal, makes it important and valid for the continuation of the study of patients with androgen deficiency, the discovery of clinical and laboratory criteria for diagnosis and the development of methods for correcting androgen deficiency in women of all ages.